Ankle Valgus in Cerebral Palsy

  • Freeman MillerEmail author
Living reference work entry


Valgus deformity of the ankle joint has been well recognized as part of the external rotation planovalgus collapse of the paralyzed foot most commonly seen in spina bifida. This same association has been reported in spastic planovalgus feet of children with cerebral palsy (CP), as an unrecognized contributor of hindfoot valgus. Also, there is a well-defined syndrome of increasing ankle valgus when a section of the fibula is resected for use as bone graft. Although the ankle valgus in spastic feet is not as profound as in the paralyzed foot of spina bifida, it is nevertheless significant in some children. The ankle valgus is rarely an isolated primary deformity in spastic feet, although it may be the primary deformity in rare children who are ambulatory with primary hypotonic CP. A common factor in ankle valgus in children with CP is that it is very often missed initially. Ankle valgus is a secondary deformity associated with planovalgus and external tibial torsion. The planovalgus may be appropriately treated but then when the patient still presents with what appears to be a valgus foot during stance phase of gait. The most important aspect of ankle valgus is recognizing when it is present. Treatment options include correction associated with a tibial osteotomy and medial malleolus screw epiphysiodesis. The goal of this chapter is to define the situations where ankle valgus is a problem, how to diagnose it, and the treatment options.


Cerebral palsy Ankle valgus Ankle epiphysiodesis Screw epiphysiodesis 


  1. Beals RK (1991) The treatment of ankle valgus by surface epiphyseodesis. Clin Orthop 266 SRC – GoogleScholar:162–169Google Scholar
  2. Davids JR (2010) The foot and ankle in cerebral palsy. Orthop Clin North Am 41:579–593CrossRefPubMedGoogle Scholar
  3. Davids JR, Valadie AL, Ferguson RL, Bray EW III, Allen BL Jr (1997) Surgical management of ankle valgus in children: use of a transphyseal medial malleolar screw. Orthop 17 SRC – GoogleScholar:3–8Google Scholar
  4. Dias LS (1985) Valgus deformity of the ankle joint: pathogenesis of fibular shortening. Orthop 5 SRC – GoogleScholar:176–180Google Scholar
  5. Hsu LC, Yau AC, O’Brien JP, Hodgson AR (1972) Valgus deformity of the ankle resulting from fibular resection for a graft in subtalar fusion in children. Joint Surg Am 54 SRC – GoogleScholar:585–594CrossRefGoogle Scholar
  6. McCall RE, Lillich JS, Harris JR, Johnston FA (1985) The Grice extraarticular subtalar arthrodesis: a clinical review. Orthop 5 SRC – GoogleScholar:442–445Google Scholar
  7. Scott SM, Janes PC, Stevens PM (1988) Grice subtalar arthrodesis followed to skeletal maturity. Orthop 8 SRC – GoogleScholar:176–183Google Scholar
  8. Stevens PM, Belle RM (1997) Screw epiphyseodesis for ankle valgus. Orthop 17 SRC – GoogleScholar:9–12Google Scholar
  9. Tompkins M, Eberson C, Ehrlich M (2012) Hemiepiphyseal stapling for ankle valgus in multiple hereditary exostoses. Am J Orthop (Belle Mead NJ) 41:E23–E26Google Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.AI DuPont Hospital for ChildrenWilmingtonUSA

Section editors and affiliations

  • Freeman Miller
    • 1
  1. 1.AI DuPont Hospital for ChildrenWilmingtonUSA

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